1538414628 NPI number — MS. MARTHA GAYNELLE HENSLEE-OLIVER LCSW

Table of content: MS. MARTHA GAYNELLE HENSLEE-OLIVER LCSW (NPI 1538414628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538414628 NPI number — MS. MARTHA GAYNELLE HENSLEE-OLIVER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENSLEE-OLIVER
Provider First Name:
MARTHA
Provider Middle Name:
GAYNELLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENSLEE
Provider Other First Name:
GAY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1538414628
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UT HEALTH, DEPT. OF PEDIATRICS, 6431 FANNIN
Provider Second Line Business Mailing Address:
JJL332B
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-500-6439
Provider Business Mailing Address Fax Number:
713-500-0543

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UTHSCH, 6431 FANNIN
Provider Second Line Business Practice Location Address:
JJL332B
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-500-6439
Provider Business Practice Location Address Fax Number:
713-500-0543
Provider Enumeration Date:
07/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  15894 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com